Journal of Agricultural and Veterinary Sciences
Qassim University, Vol. 4, No. 1, pp. 67-80 (January 2011/Moharram 1432H)
Diagnostic Ultrasonography in Cattle and Buffaloes
with Intestinal Obstruction
M. Tharwat
Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Egypt. Present
address: Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim
University, Buraydah, Qassim, Saudi Arabia Tel.: 00966-500960421, Email address:
[email protected]
(Received 7/3/2010; accepted for publication 9/7/2010)
Abstract. The aim of this study was to evaluate the importance of ultrasonography in diagnosis of
intestinal obstruction and to find out whether ultrasound could be used as a decision-making tool in cattle
and buffaloes suffering from intestinal obstruction. For this purpose, cows (n=8), calves (n=6) and
buffaloes (n=4) with intestinal obstruction were investigated. Animals were admitted because of anorexia,
abdominal distension, absence of defecation and signs of colic. Based on the clinical examination
findings, a tentative diagnosis of intestinal obstruction was made. Laboratory results showed neutrophilic
leukocytosis, hypoproteinemia, hyperglycemia, elevated blood urea nitrogen and severe hypokalemia and
hypochloremia. In cross section, ultrasonographic findings of intussusception showed that the invaginated
intestinal wall was swollen, the affected area of intestine appeared hyperechogenic or hypoechogenic.
When viewed longitudinally, the typical lumen-within a-lumen appearance had a ‘‘sandwich’’
configuration. Other ultrasonographic findings included increased diameter and decreased motility of the
small intestine. Hypoechogenic fluid was visible between the dilated loops of intestine. The loops of
small intestine were most commonly imaged in cross-section and longitudinally. The contents of the
small intestine appeared either echogenic or anechoic. The common gross pathologic findings observed
postmortem were variable lengths of dark purple-red distended loops of small intestines. A jejuno–jejunal
intussusception associated with mild acute fibrinous peritonitis was also detected. Ultrasound
examination of the intestine is practically useful in cattle and buffaloes that are suspected of intestinal
obstruction. This imaging technique allows one to confirm or rule out preliminary diagnosis and to decide
whether surgery or slaughter is recommended.
Keywords: buffaloes, calves, cattle, intestinal obstruction, ultrasonography
67
68
M. Tharwat
Introduction
In cattle and buffaloes, there are many causes of obstruction of the small intestine
such as intussusception and volvulus (Pearson and Pinsent 1977; Horney and
Wallace 1984; Pravettoni et al., 2009) and herniation through the right lateral
ligament of the bladder (Trent and Bailey 1985). Incarceration of the small intestine
by remnants of the ductus deferens has also been described (Wolfe et al., 1987;
Scott et al., 1997). Potential causes are mechanical obstruction due to feed boluses,
blood clots or hairballs, narrowing of the duodenal lumen due to liver abscesses in
the area of the sigmoid flexure, or adhesions resulting from such abscesses (Wolfe et
al., 1987; Scott et al., 1997; Abutarbush and Radostits 2004).
Intussusception occurs when a segment of the gastrointestinal tract telescopes
into an adjacent one, causing intestinal obstruction. The outer receiving segment and
the inner inverting segment are called intussuscipiens and intussusceptum,
respectively (Pearson 1971; Constable et al., 1997; Byrne et al., 2005). The etiology
of intussusception is referable to several disorders of intestinal motility. Essential
factors are strong peristalsis in one bowel segment and distension of the segment
immediately distal to it (Pearson 1971). Submucosal abscesses, fibroserous
granulation (Okamoto et al., 2007), intestinal tumors such as mucosal papilloma or
adenocarcinoma (Archer et al., 1988), and enteritis resulting in vigorous and
uncoordinated intestinal motility or hypermotility and gas distension are considered
to be predisposing factors (Pearson 1971). In a study of 336 cattle with
intussusception, the small intestine was primarily involved in 281 (84%) cases.
Other sites were: the ileocolic segment in 7 cases (2%), the cecocolic segment in 12
cases (4%) and the colon in 36 cases (11%) (Constable et al., 1997). Intussusception
is frequently observed in adult animals (Dziuk and Usenik 1964; Pearson 1971) but
appears to be most common in calves up to 2 months old (Constable et al., 1997).
Clinical signs of small intestinal obstruction in cattle include anorexia,
depression, dehydration, tachycardia, and abdominal pain (Pearson and Pinsent
1977). The presence of right-sided abdominal tympanitic resonance (ping) is a
consistent clinical finding in cattle with right displacement of the abomasum
(Robertson 1965; Smith et al., 1982). Other less common causes of rightsided pings
include abomasal volvulus, distension of the proximal colon, caecal distension or
volvulus, pneumorectum, pneumoperitoneum, physometra, ileus, and distension of
the small intestine (Pearson and Pinsent 1977; Hull 1982; Smith et al., 1982;
Rebhun 1991). Other signs frequently observed in small intestinal obstruction
include a marked decrease in fecal output and bilateral abdominal distention.
Multiple loops of distended small intestine are usually palpable per rectum (Pearson
and Pinsent 1977).
Cattle with paralytic ileus show unspecific clinical signs, such as moderate to
severely decreased body condition, anorexia, reduced or absent peristalsis, and
Diagnostic Ultrasonography in Cattle …
69
reduced or delayed defecation. Transrectal palpation of abdominal viscera is also
non-specific, and no distended intestinal loops are palpable (Smith 2002; Radostits
et al., 2007). Therefore, objectives of the present study were to characterize the
importance of ultrasonography in early diagnosis of intestinal obstruction in a step
to improve prognosis.
Materials and Methods
Animals, history, clinical, laboratory and postmortem examinations
In the present study, eighteen cattle and buffaloes were examined. They included 8
cows, 6 calves and 4 buffaloes. Cows and buffaloes were between 2 to 6 years of
age, while calves were aged between 1 to 4 months. Animals were admitted because
of anorexia, abdominal distension, absence of defecation and signs of colic.
Ultrasonographic examinations were carried out at Veterinary Teaching Hospital,
Zagazig University, Egypt between 2004 and 2007 and in Qassim University,
Veterinary Teaching Hospital, Saudi Arabia between 2007 and 2010. Animals had
been ill for 3 to 13 days before admission. All animals underwent a through clinical
examination as described previously (Rosenberger 1990; Radostits et al., 2000),
which included general behavior and condition, auscultation of the heart, lungs,
rumen and intestine, measurement of heart rate, respiratory rate and rectal
temperature, swinging auscultation, percussion auscultation of both sides of the
abdomen and rectal examination. In cows and buffaloes, rectal examination was also
carried out. Animals were treated with penicillin streptomycin 40.000 IU/kg BW
IM/3d, non-steroidal anti-inflammatory (flunixin meglumine) 2.5 mg/kg BW IV/3d
and Ringer solution (large animals: 6L daily; calves: 2L daily IV/3d) for three
successive days. Adult and young animals were also treated with 3L and 300mL of
liquid paraffin, respectively. If no response was seen, additional two doses of the
mineral oil were given, 12h apart. Four cows, four calves and two buffaloes did not
respond to medical treatment and therefore were slaughtered and thoroughly
examined postmortem.
Two blood samples were collected by puncture of the jugular vein into tubes
containing EDTA and plain tubes. A complete blood count (hematocrit, total and
differential leucocyte) was carried out on the first blood sample. After centrifugation
of the second blood sample, serum samples were collected and then frozen for later
analysis of clinical chemistries. The concentrations of total protein, calcium,
phosphorus, glucose, urea nitrogen (UN), sodium, potassium and chloride were
determined in serum using commercial kits. The activities of enzymes aspartate
aminotransferase and γ-glutamyl transpeptidase were also measured in serum
samples.
70
M. Tharwat
Ultrasonographic examination
Ultrasonographic examination was carried out by the methods described
previously (Mohamed and Oikawa 2007; Braun 2009) using 3.5 and 5.0 MHz sector
transducers (Pie Medical 240 Parus, The Netherlands). The hair at the examination
area was clipped and the skin was shaved. After the application of transmission gel
to the transducer, the animals were examined beginning at the ventral abdomen and
extending forward to the third intercostal space on both sides of the thorax. In the
abdomen, the peritoneum, rumen, reticulum, omasum, abomasum, spleen, small and
large intestines, liver, pancreas and right kidney were examined.
Statistical analysis
Data of hematological and biochemical findings were analyzed, using oneway analysis of variance (ANOVA). Values are expressed as mean ± SD.
Results
On clinical examination, the physical condition of the animals was fair in 11 animals
and poor in seven. They had a rectal temperature of 39.4 ± 0.8°C, 32 ± 14 breaths/
min, pulse rate of 90 ± 22 beats/min. The mucous membranes were cyanotic in eight
animals and pale in six, and the episcleral vessels were congested in five. Bilateral
abdominal distension was observed in fifteen animals (Figure 1) and abdominal
auscultation revealed reduced peristaltic squishing sounds of the intestine in twelve.
Distension was being more evident over the right paralumbar fossa with recumbency
in thirteen animals. Signs of abdominal pain (stretching, anxious, looking at the
affected site) were detected in five animals (Figure 2).
On abdominal auscultation, no ruminal contractions were heard over 3 min in
eleven animals, and no intestinal sounds could be detected in sixteen cases. Ping
sounds were created by abdominal percussion with auscultation in fifteen animals,
and simultaneous ballottement and auscultation of the right side of the abdomen
produced fluid-splashing sounds in ten animals that indicated an abnormal
accumulation of fluid in the gastrointestinal viscera. Signs of dehydration (sunken
eyeballs, reduced skin turgor) were noticed in fifteen cases (Figure 3). A rectal
examination revealed an absence of feces in the rectum in sixteen animals with
presence of mucus, distended and tense loops of intestines in nine cases, L-shaped
distended rumen in four animals and two had small amount of dark tarry feces
(Figure 1). Based on the clinical examination findings, a tentative diagnosis of
intestinal obstruction was made. Blood chemical analysis showed the presence of
neutrophilic leukocytosis, hyperprotenemia, elevated UN concentrations and
hyperglycemia. The most important biochemical findings were severe hypokalemia
and hypochloremia (Table 1).
Diagnostic Ultrasonography in Cattle …
71
Ultrasonographic findings of intussusception were apparent in four animals.
In a cross section, the invaginated intestinal wall was swollen, the affected area of
intestine appeared hyperechogenic in one animals and hypoechogenic in three.
When viewed longitudinally, the typical lumen-within a- lumen appearance had a
‘‘sandwich’’ configuration. The most important ultrasonographic findings of the
affected animals included increased diameter and decreased motility of the small
intestine. The small intestine was dilated in at least one area and had a diameter of
5±4 cm. The motility of the small intestine was usually reduced or absent.
Hypoechogenic fluid, which is attributable to transudation, was visible between the
dilated loops of intestine (Figure 4). Independent of the localization of the paralytic
ileus and its cause, the loops of small intestine were most commonly imaged in
cross-section and longitudinally (Figure 5). The contents of the small intestine
appeared echogenic in fourteen animals and anechoic in four. Intraluminal gas,
which was associated with reverberation artifacts, was observed in one case. Causes
of obstruction were difficult to be determined ultrasonographically, often because
the cause of paralytic ileus is farther from the abdominal wall than the penetration
capacity of the transducer.
The common postmortem gross pathologic findings were variable lengths of
dark purple-red distended jejunum with an intraluminal blood clot (Figure 6 A and
B). The small intestines proximal to the lesion were distended with fluid and ingesta,
because the outflow was obstructed. Necropsy also revealed a jejuno–jejunal
intussusception involving a large, 30-cm tract of small intestine, and associated with
mild fibrinous acute peritonitis. The portion of the invaginated jejunum revealed
signs of transmural necrosis, infarction, large hemorrhagic areas, and fibrin deposits
on the serous and mucosal surfaces. Intense hyperemia, acute catarrhal enteritis, and
moderate- to-severe serofibrinous deposits affected the portion of small intestine
preceding the intussusception. There were several loops of dilated small intestine,
some of which were adhered together by plaques of fibrin; which were carefully
separated. The distal part of the small intestine (jejunum) had a palpable distension.
Enterotomy revealed a hairball in 2 calves. The segment of small intestine between
the strangulated areas was dilated and had focal infarcts. Segments of small intestine
proximal to the strangulation were distended with gas (Figure 6 E and F). Other
postmortem findings included distended rumen and abomasum (Figure 7).
72
M. Tharwat
Figure (1). Clinical presentations in six cows affected with intestinal obstruction. Bilateral
abdominal distension is apparent in A, B, C, D and F. During rectal examination, a
black tarry feces was seen in F.
Diagnostic Ultrasonography in Cattle …
73
Figure (2). Clinical presentations in a buffalo affected with intestinal obstruction. Signs of
abdominal pain (stretching and looking at affected side) are apparent.
Figure (3). Clinical presentations in two calves affected with intestinal obstruction. Depression of
the cases and recumbency is evident. Pictures B and D point to mucus in the perineal region.
74
M. Tharwat
Figure (4). Intestinal obstructions in cattle and buffaloes. Ultrasonograms of cross-sections through
dilated jejunum (A, C and D) and duodenum (B) in one cow (A), one calf (B) and two
buffaloes (C and D). Loops of small intestine are dilated and immotile. Note the
abdominal fluid (*) in image A.
Figure (5). Ultrasonogram of cross-sections and longitudinal views of dilated loops of jejunum in
one cow (A and B) and one buffalo (C and D) with intestinal obstruction. The
transducer was placed in the right ventral abdomen. The contents of the loops viewed
in cross-section appear hypoechogenic and those of the loops viewed longitudinally
have an echogenic appearance. (1) Abdominal wall, (2) loop of jejunum in cross-section,
(3) loop of jejunum viewed longitudinally. Ds: dorsal and Vt: ventral
Diagnostic Ultrasonography in Cattle …
75
Figure (6). Pathologic findings in cases with intestinal obstruction. Dark purple-red distended jejunum
is apparent (A and B). Intussusception of the intestine is shown (C and D). Segments of
small intestine proximal to the strangulation are distended with gas (E and F).
76
M. Tharwat
Figure (7). Additional pathologic findings in animals with intestinal obstruction where distended
abomasums are seen.
Table (1). Hematological and biochemical findings in cattle and buffaloes with intestinal
obstruction
Parameters
Finding (n = 18)
Hematocrit (%)
41±7
Reference value #
24-46
Leukocyte count (/µL)
14675±2196*
4000-12000
Neutrophils (/µL)
11887±1660**
600-4000
2500-7500
Lymphocytes (/µL)
2172±616
Total protein (g/dL)
8.9±0.48*
6.7-7.5
Glucose (mg/dL)
131±22*
45-75
Calcium (mg/dL)
9.3±1.3
9.7-12.4
Phosphorus (mg/dL)
6.4±1.4
3.9-9.2
Aspartate aminotransferase (U/L)
99±27
78-132
γ-glutamyl transferase (U/L)
31±11
6.1-17.4
Sodium (mmol/L)
137±6
132-152
Potassium (mmol/L)
2.8±0.5*
3.9-5.8
Chloride (mmol/L)
76±10*
95-110
Urea nitrogen (mg/dL)
63±25*
# Radostits et al., 2007; Kaneko et al., 1997
Data are expressed as mean ± SD. * P < 0.05; ** P < 0.01
6.0-26
Diagnostic Ultrasonography in Cattle …
77
Discussion
Until relatively recently, exploratory laparotomy was the method to investigate
unexplained abdominal illnesses in cattle. Exploratory laparotomy should be
avoided in animals with poor prognosis because it inflicts additional pain, is
expensive and the animal usually cannot be slaughtered for human consumption for
some time after the operation (Radostits et al., 2007).
In the preset study, the results of the clinical and biochemical examinations
were non-specific and do not surely reflect the exact diagnosis. Even experienced
clinicians may not be able to pinpoint the obstruction site and make an accurate
diagnosis. In addition, while transrectal examination of the abdominal cavity of
adult cattle and buffaloes with signs of intestinal obstruction was often a useful
diagnostic aid, this is not possible in the young calves because of their small body
size. The clinical and blood chemical findings corresponded to those reported in the
literature. Animals were hyperglycemic due to stress and azotemic due to
dehydration (Smith 2002). The most important biochemical findings were the
pronounced hypokalemia and hypochloremia. This important finding may be due to
abomasoruminal reflux caused by intestinal obstruction (Radostits et al., 2007).
In humans and many animal species, transabdominal ultrasonography is an
excellent diagnostic procedure for abdominal disorders (Braun 2009). In this study,
the ultrasonographic appearance of the intussusception corresponds to that described
using a 3.5 MHz transducer in horses (Bernard et al., 1989; Fontaine-Rodgerson and
Rodgerson 2001). Ultrasonographic examination of the right side of the abdominal
cavity has been shown to be a useful diagnostic tool when paralytic ileus is
suspected (Braun 2003). Ultrasonographic findings are known to help in differential
diagnoses, such as right abomasal displacement and pyloric stenosis (Braun et al.,
1993). The extent of the duodenal alterations could also be estimated. It was not
possible to determine the cause of the obstruction despite ultrasonagraphic
localization of the problem in this study. This situation corresponds to published
findings (Braun 2003) and reflects the fact that the area in which the problem arises
is often too distant from the abdominal wall for ultrasonographic examination.
Rectal examination was not considered appropriate in calves during the present
study because of the difficulty in palpation. Transabdominal ultrasonography was
found to be useful alternative.
In conclusion, ultrasound examination of the intestine is particularly useful in
cattle and buffaloes that are suspected of having paralytic ileus but do not have
corresponding diagnostic rectal findings. This imaging technique allows one to
confirm or rule out paralytic ileus and to decide on surgery or slaughter. In cattle
with reduced or no fecal output and dilated loops of intestine seen via
ultrasonography, a decision of laparotomy or slaughter must be made.
Acknowledgement.
The author would like to thank Professor Osama Mahmoud (Pathology,
Qassim University) for his constructive comments.
78
M. Tharwat
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‫‪M. Tharwat‬‬
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‫اﻟﻜﻠﻤﺎت اﻟﻤﻔﺘﺎﺣﻴﺔ‪:‬א'"س‪،‬א*)‪،‬א‪-.‬אدא*"‪،F,‬אقא‪ K‬‬